Vasc-Alert helps you comply with guideline 4, "Detection of Access Dysfunction: Monitoring, Surveillance, and Diagnostic Testing.” The Clinical Practice Recommendations are listed below. You can download a copy of the guideline here:
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1. 4.1 Monitoring the access:
   
   
   1. 4.1.1 Access patency should be ensured before each treatment before any attempts to cannulate the access.
      
      
   2. 4.1.2 All caregivers, including fellows in training, should learn and master the methods for examining a vascular access.
      
      
   3. 4.1.3 Access characteristics, such as pulsatility and presence of thrill, as well as flow and pressure, should be recorded and tracked in a medical record and be available to all caregivers on the VAT.
   
   
   
2. 4.2 Frequency of measurement is dependent on the method used:
   
   
   1. 4.2.1 It is not clear that access flow measurements performed at a monthly frequency provided sufficient data stability to make decisions. Until additional studies are performed to determine optimal frequency, more frequent measurements are recommended.

      Vasc-Alert tests the access with every treatment.

   2. 4.2.2 Static pressure measurements require less technology and should be made more frequently than flow measurements. Direct measurements of static pressure ratios should be made every 2 weeks. Less-direct measurements should be made weekly. Dynamic pressures, if used (see CPG 4.2.3), should be measured with each dialysis treatment, but derivation of a static pressure should be attempted, rather than using the raw numbers.
      
      
   3. 4.2.3 Measurement of recirculation is not recommended as a surveillance technique in grafts.
      
      
3. 4.3 Frequency of measurement for access complications:
   
   
   1. 4.3.1 Thrombosis in fistulae develops more slowly than in grafts. Flow measurements performed at a monthly frequency appear to be adequate. Until additional studies are performed to determine optimal frequency, less frequent measurements are not recommended.
      
      
   2. 4.3.2 Because static pressure measurements are inherently less accurate in detecting access stenosis in fistulae, the frequency should not be less than in grafts. Direct measurements of static pressure ratios should be made every 2 weeks. Less-direct measurements should be made weekly. Dynamic pressures should be measured with each dialysis. Increased recirculation can indicate reduced effective blood pump flow, resulting in inadequate dialysis.
      
      
4. 4.4 Diagnostic testing:
   
   
   1. 4.4.1 Characteristics of access (see CPR 4.1), as well as blood pump flow and pressure performance, should be recorded and tracked in medical records.

      Vasc-Alert gives you a six month history of venous pressure, blood flow rate and negative arterial pressure on every report.

   2. 4.4.2 Data should be analyzed at least monthly to evaluate access dysfunction.
      
      
   3. 4.4.3 After intervention, the surveillance parameter should be restored to normal.

      Interpretation: When a patient returns from intervention, the surveillance test in use should be performed to ensure that patency has been restored.

   4. 4.4.4 Data should be analyzed to improve success rates and ensure that interventions are properly assessed. For example, PTA and surgical revision rates, recurrence rates, and number of procedures should be systematically analyzed in a CQI process.
      
      
   5. 4.4.5 A multidisciplinary team should be involved.
      
      
   6. 4.4.6 Preemptive correction of hemodynamically significant stenosis should remain the standard of care.